Evidence Summary


Lack of Training and a Self-Service Environment Leaves Staff and Users Uncertain About Health Information in a Public Library Setting


A Review of:

Harris, R., Henwood, F., Marshall, A., & Burdett, S. (2010). “I'm not sure if that's what their job is." Consumer health information and emerging "healthwork" roles in the public library. Reference and User Services Quarterly, 49(3), 239-252.


Reviewed by:

Kate Kelly


Royal College of Surgeons in Ireland

Dublin 2, Ireland

Email: katekelly@rcsi.ie


Received: 1 June 2011                                                                   Accepted: 5 Oct. 2011



Description: cc-ca_logo_xl 2012 Kelly. This is an Open Access article distributed under the terms of the Creative CommonsAttributionNoncommercialShare Alike License 2.5 Canada (http://creativecommons.org/licenses/byncsa/2.5/ca/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes, and, if transformed, the resulting work is redistributed under the same or similar license to this one.





Objective – To explore the role and expectations of patrons and staff about the role of a public library in enabling citizens’ “health information work.” This involves helping citizens take responsibility for their own health care by finding and using health information.


Design – Case study.


Setting – A single, UK public library with a self-service delivery model based in a city centre in the spring of 2006. Self-service also applies to reference services and is designed to “empower users to locate and use information on their own.”


Subjects – 202 library visitors who came to the library specifically to find health information completed a questionnaire, 15 of these visitors were later interviewed; 19 library staff (10 librarians, 6 library officers and 3 senior managers).


Methods – Mixed quantitative and qualitative methods. A print questionnaire was administered to adult library users (age 18 and over). Semi-structured interviews were conducted with fifteen randomly selected library users who completed the questionnaire, sixteen library staff who worked directly with library users, and with three librarians in senior management positions in the library. Descriptive statistics were calculated from the questionnaire, recorded interviews were transcribed, and the text analyzed to identify recurring themes.


Main Results – While all respondents came to the library to seek health information results from the questionnaire found that half (50%) of respondents came to the library to look for information on a specific health problem; 37% of respondents had tried finding information elsewhere before coming to the library; 40% usually searched the Internet when they needed health information or advice although only 32% reported trusting the Internet somewhat or completely; 67% intended to borrow books; only 4% indicated that they had planned to ask library staff for help; and 59% reported finding what they were looking for by themselves. 


Results from the interviews found users, front line staff, and managers in general agreement about the role of the library as a starting point for health information, and that the library was a neutral and non-threatening environment.  There was also agreement among the three groups interviewed that the public library fills a gap when health care providers, particularly doctors, are unable to meet the information needs of some of their patients. Library staff were concerned about interpreting information as well as the impact of a self-service philosophy on the quality and length of interactions with users, and seemed unclear about their role in relation to health information provision.  Library staff had no training in supporting health information and limited or no knowledge of authoritative online health resources and how to use them, and their approach to Internet searching was similar to users. This lack of training and expertise appeared obvious to library users. Users did not identify interpretation of information by librarians as an issue but did reference the impact of self-service and the Internet on the role and morale of the library staff. Neither library users nor library staff identified librarians as a resource to be used when seeking health information. The value of the library for users was the book collection and they saw the library as second only to physicians as a source of trustworthy information. 

Conclusion – Uncertainty about the role of librarians in health information provision was evinced by both librarians and library users. Both groups were also uncertain about the relationship between self-service and technology, and the way in which librarians and their work are almost invisible. Health policies emphasize personal responsibility for health yet individuals are not enabled to find answers to their questions. The absence of health knowledgeable front line staff in public libraries is “worrisome.” The obvious trust users have in the library suggests that efforts to develop consumer health information in these settings continue to be a worthwhile response to the “pressures on citizens to take responsibility for their health”.





As this is an exploratory case study the findings cannot be generalized to all public libraries. The policy context of increasing personal responsibility for health care is well made as is the difficulty lay searchers experience using the Internet to find health information.


The interim between when the research was conducted and its publication has seen pertinent publications on the topic of consumer health and public libraries published both in the U.S. and the U.K.  It was surprising, though, not to see reference in the discussion or literature review to older studies and guidelines such as the Health Link feasibility study (2005) which specifically references the potential of UK public libraries in health information provision or the 2001 ALA reference service guidelines for handling medical queries.


The lack of knowledge of staff and management in the library under study about issues surrounding the provision of healthcare information in public libraries is indeed “worrisome.” Consumer health information delivered via public libraries or in partnership with health sciences libraries is not a new idea and there are resources targeted at librarians available through professional associations and publications (see reference list.) In highlighting the uncertainty of staff and their concerns around interpreting health information, the article mostly reinforces what is already known about health information delivery in a public library setting. The most striking theme in this article is the invisibility of librarians in the library studied and the effect of pursuing a self-service delivery model. In this reviewer’s opinion it is the uncovering of the impact of the self-service model on the quality of interactions which gives value to this article and which may give pause for thought if the public library is to play a role in enabling citizens to take responsibility for their own health care.





American Association for the Advancement of Science, AAAS. (2010). The challenge of providing consumer health information services in public libraries. Retrieved 13 Feb. 2012 from http://www.healthlit.org/pdfs/AAASFINAL.pdf


Baker, L. M., & Manbeck, V. (2002). Consumer health information for public librarians. Lanham, MD: Scarecrow Press.


Business Reference and Services Section, Reference and User Services Association. (2001). Guidelines for medical, legal, and business responses. Retrieved 13 Feb. 2012 from http://www.ala.org/rusa/resources/guidelines/guidelinesmedical


Casini, B., & Kenyon, A. (2002). The public librarian's guide to providing consumer health information. Chicago: Public Library Association.


Consumer and Patient Health Information Section (CAPHIS) of the Medical Library Association. Consumer health information: A selected bibliography. Retrieved 15 Feb. 2012 from http://caphis.mlanet.org/chis/bibliography.html


Health Link. (2005). Feasibility study information and support for patient choice and the public library service. Retrieved 13 Feb. 2012 from   http://www.healthlinklibraries.co.uk/resources_references.asp

Smith, S., & Duman, M. (2009). The state of consumer health information: An overview.  Health Information & Libraries Journal, 26(4), 260–278.


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